HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fell, S. C. Articles by Veith, F. J. Search for Related Content PubMed PubMed Citation Articles by Fell, S. C. Articles by Veith, F. J.

The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 172-178, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Revascularization of ischemic bronchial anastomoses by an intercostal pedicle flap

SC Fell, FP Mollenkopf, CM Montefusco, S Mitsudo, SL Kamholz, J Goldsmith and FJ Veith

Ischemia of the donor bronchus, perfused solely by retrograde collaterals from the pulmonary circulation, is an important factor in the impaired healing of the bronchial anastomosis of transplanted lungs. The healing of two experimental models of bronchial anastomotic ischemia, the bronchial segmental autograft and the postpneumonectomy bronchial autograft, was assessed in dogs. The application of a polytetrafluoroethylene wrap to the bronchial segmental autograft and the application of an intercostal pedicle flap to the postpneumonectomy bronchial autograft, with and without concomitant administration of corticosteroids, were also studied to elucidate factors that affect bronchial anastomotic healing. The bronchial segmental autograft healed normally without stricture, but isolation of this autograft from the mediastinum and lung by the polytetrafluoroethylene wrap resulted in necrosis of the autograft. All dogs that had a postpneumonectomy bronchial autograft died of bronchopleural fistulas due to autograft necrosis. Application of an intercostal pedicle flap to the autograft resulted in healing in all animals. Arteriography and Microfil injection demonstrated revascularization of the postpneumonectomy bronchial autograft by the pedicled intercostal artery. Several conclusions can be drawn: With the lung in situ the bronchial segmental autograft survives, probably as a free composite graft. In contrast, the postpneumonectomy bronchial autograft is an excellent model of bronchial anastomotic ischemia. The intercostal pedicle flap is a reliable method for providing neovascularity and mechanical reinforcement to an ischemic bronchial anastomosis. Its effect on bronchial anastomotic healing was not diminished by administration of corticosteroids. The intercostal pedicle flap may be useful in preventing bronchial anastomotic complications in clinical lung transplantation.

This article has been cited by other articles:

				M. M. Mughal, T. R. Gildea, S. Murthy, G. Pettersson, M. DeCamp, and A. C. Mehta Short-Term Deployment of Self-Expanding Metallic Stents Facilitates Healing of Bronchial Dehiscence Am. J. Respir. Crit. Care Med., September 15, 2005; 172(6): 768 - 771. [Abstract] [Full Text] [PDF]

				R. J. Cerfolio, A. S. Bryant, and M. Yamamuro Intercostal Muscle Flap to Buttress the Bronchus at Risk and the Thoracic Esophageal-Gastric Anastomosis Ann. Thorac. Surg., September 1, 2005; 80(3): 1017 - 1020. [Abstract] [Full Text] [PDF]

				B. H. Kwek, J. C. Wain, and S. L. Aquino The radiologic appearance of intercostal muscle flap Ann. Thorac. Surg., August 1, 2004; 78(2): 432 - 435. [Abstract] [Full Text] [PDF]

				H. C. Grillo Tracheal replacement: a critical review Ann. Thorac. Surg., June 1, 2002; 73(6): 1995 - 2004. [Abstract] [Full Text] [PDF]

				M. E. Deeb, D. H. Sterman, J. B. Shrager, and L. R. Kaiser Bronchial anastomotic stricture caused by ossification of an intercostal muscle flap Ann. Thorac. Surg., May 1, 2001; 71(5): 1700 - 1702. [Abstract] [Full Text] [PDF]

				J.-F. Regnard, M. Alifano, P. Puyo, E. Fares, P. Magdeleinat, and P. Levasseur Open window thoracostomy followed by intrathoracic flap transposition in the treatment of empyema complicating pulmonary resection J. Thorac. Cardiovasc. Surg., August 1, 2000; 120(2): 270 - 275. [Abstract] [Full Text] [PDF]

				T. Hasegawa, A. T. Iacono, P. D. Orons, and S. A. Yousem Segmental nonanastomotic bronchial stenosis after lung transplantation Ann. Thorac. Surg., April 1, 2000; 69(4): 1020 - 1024. [Abstract] [Full Text] [PDF]

				S. C. Fell Heterotopic ossification in pedicled intercostal muscle flaps causing clinical problems J. Thorac. Cardiovasc. Surg., July 1, 1998; 116(1): 182 - 182. [Full Text]

				R. Prommegger and G. M. Salzer Heterotopic ossification in pedicled intercostal muscle flaps causingclinical problems J. Thorac. Cardiovasc. Surg., February 1, 1998; 115(2): 466 - 467. [Full Text] [PDF]

				V. R. Kshettry, T. J. Kroshus, M. I. Hertz, D. W. Hunter, S. J. Shumway, and R. M. Bolman III Early and Late Airway Complications After Lung Transplantation: Incidence and Management Ann. Thorac. Surg., June 1, 1997; 63(6): 1576 - 1583. [Abstract] [Full Text]

				E. A. Rendina, F. Venuta, P. Ricci, G. F. Fadda, D. A. Bognolo, C. Ricci, and P. Rossi Protection and revascularization of bronchial anastomoses by the intercostal pedicle flap J. Thorac. Cardiovasc. Surg., May 1, 1994; 107(5): 1251 - 1254. [Abstract] [Full Text]

				J. F. Regnard, P. Icard, M. Deneuville, B. Jauffret, P. Magdeleinat, J. F. Levi, and P. Levasseur Lung resection after high doses of mediastinal radiotherapy (sixty grays or more)Reinforcement of bronchial healing with thoracic muscle flaps in nine cases J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 607 - 610. [Abstract] [Full Text]